Anamaria Siriani de Oliveira

Prevalence study of signs and symptoms of temporomandibular disorder in Brazilian college students

The aim of this study was to evaluate the prevalence and severity of temporomandibular disorders (TMD) in Brazilian college students. A questionnaire was administered to 2,396 students. Seventy-three percent of women (mean age 21.94 +/- 5 years) and 27% of men (mean age 22.41 +/- 4.8 years) answered the questionnaire. The anamnestic index was used to classify the volunteers according to TMD severity degree. The results showed a higher percentage of men without TMD (43.74%) (p < 0.05, Chi-square test). The women exhibited some degree of severity (73.03%) at a higher frequency than men (56.26%). No significant differences were observed between sexes for a same TMD severity degree (p > 0.05). The results indicated TMD prevalence in Brazilian college students similar to that presented in other studies found in the literature reviewed. Longitudinal studies are recommended to follow the prevalence and health care needs in this population.

Use of the Fonseca's questionnaire to assess the prevalence and severity of temporomandibular disorders in brazilian dental undergraduates

This study to assessed the prevalence of signs and symptoms of temporomandibular disorders (TMD) by means of the frequency distribution of data for 218 dentistry students from a Brazilian public university using the Fonsecas questionnaire. The group consisted of 96 men and 122 women, with an average age of 20 years. Of the students, 53.21% showed some level of TMD: 35.78% mild TMD 11.93% moderate and 5.5% severe. Women were the most affected group, with 63.11% showing some level of TMD, against 40.62% of men. When considering only severe TMD, women are approximately 9 times more affected than men. Students with any level of TMD showed marked characteristics: 76.72% considered themselves tense people; 71.55% reported to clench or grind their teeth; 65.52% reported clicking of the temporomandibular joint; 64.66% reported frequent headache and 61.21% neck pain. In conclusion, clinical signs and symptoms of TMD can occur in young population and this information is of great importance for the early diagnosis of the dysfunction.

Reliability assessment of Cobb angle measurements using manual and digital methods.

BACKGROUND CONTEXT The vertebral spine angle in the frontal plane is an important parameter in the assessment of scoliosis and may be obtained from panoramic X-ray images. Technological advances have allowed for an increased use of digital X-ray images in clinical practice. PURPOSE In this context, the objective of this study is to assess the reliability of computer-assisted Cobb angle measurements taken from digital X-ray images. STUDY DESIGN/SETTING Clinical investigation quantifying scoliotic deformity with Cobb method to evaluate the intra- and interobserver variability using manual and digital techniques. PATIENT SAMPLE Forty-nine patients diagnosed with idiopathic scoliosis were chosen based on convenience, without predilection for gender, age, type, location, or magnitude of the curvature. OUTCOME MEASURES Images were examined to evaluate Cobb angle variability, end plate selection, as well as intra- and interobserver errors. METHODS Specific software was developed to digitally reproduce the Cobb method and calculate semiautomatically the degree of scoliotic deformity. During the study, three observers estimated the Cobb angle using both the digital and the traditional manual methods. RESULTS The results showed that Cobb angle measurements may be reproduced in the computer as reliably as with the traditional manual method, in similar conditions to those found in clinical practice. CONCLUSIONS The computer-assisted method (digital method) is clinically advantageous and appropriate to assess the scoliotic curvature in the frontal plane using Cobb method.

Electromyographic Amplitude Ratio of Serratus Anterior and Upper Trapezius Muscles During Modified Push-ups and Bench Press Exercises

Imbalance and weakness of the serratus anterior and upper trapezius force couple have been described in patients with shoulder dysfunction. There is interest in identifying exercises that selectively activate these muscles and including it in rehabilitation protocols. This study aims to verify the UT/SA electromyographic (EMG) amplitude ratio, performed in different upper limb exercises and on two bases of support. Twelve healthy men were tested (average age = 22.8 ± 3.1 years), and surface EMG was recorded from the upper trapezius and serratus anterior using single differential surface electrodes. Volunteers performed isometric contractions over a stable base of support and on a Swiss ball during the wall push-up (WP), bench press (BP), and push-up (PU) exercises. All SEMG data are reported as a percentage of root mean square or integral of linear envelope from the maximal value obtained in one of three maximal voluntary contractions for each muscle studied. A linear mixed-effect model was performed to compare UT/SA ratio values. The WP, BP, and PU exercises showed UT/SA ratio mean ± SD values of 0.69 ± 0.72, 0.14 ± 0.12, and 0.39 ± 0.37 for stable surfaces, respectively, whereas for unstable surfaces, the values were 0.73 ± 0.67, 0.43 ± 0.39, and 0.32 ± 0.30. The results demonstrate that UT/SA ratio was influenced by the exercises and by the upper limb base of support. The practical application is to show that BP on a stable surface is the exercise preferred over WP and PU on either surfaces for serratus anterior muscle training in patients with imbalance between the UT/SA force couple or serratus anterior weakness.

Principais instrumentos para avaliação da disfunção temporomandibular, parte I: índices e questionários; uma contribuição para a prática clínica e de pesquisa

Na literatura especializada, encontram-se variados instrumentos para avaliacao da disfuncao temporomandibular (DTM), sob a forma de indices, questionarios, protocolos, escalas de avaliacao e criterios de diagnostico. Este estudo, dividido em duas partes, visou caracterizar os principais instrumentos de avaliacao da DTM disponiveis na literatura, para auxiliar o clinico e o pesquisador na correta escolha da ferramenta apropriada para contemplar seus objetivos clinicos ou cientificos. Nesta parte I sao apresentados dois indices clinicos e tres questionarios (anamnesicos e funcionais); na parte II, um questionario funcional e dois conjuntos de criterios diagnosticos. Os indices sao ferramentas que organizam a avaliacao de sinais e sintomas, pela obtencao de pontuacoes. Os questionarios sao melhor aplicados para tracar perfis populacionais em estudos epidemiologicos. Para avaliacao dos eventuais impactos da DTM nas atividades de vida diaria, os questionarios funcionais sao mais adequados. Finalmente, ha poucos conjuntos de criterios sistematizados para obter o diagnostico da disfuncao. A utilizacao de uma ou outra ferramenta depende de sua aplicabilidade e dos objetivos do profissional que a ira utilizar.

Anamnestic Index Severity and Signs and Symptoms of TMD

Abstract The aim of this study was to determine the frequency and to characterize the symptoms and clinical signs of temporomandibular disorders (TMD) related to each severity category of Fonseca’s anamnestic index in a sample of Brazilian young adults (mean age 21.61±1.91 years, 87% females and 13% males), by the application of an anamnestic index proposed by Fonseca (1992) and by clinical examination considering mandibular range of motion and tenderness to palpation of stomatognathic system structures. A significant number of participants were classified with mild TMD (43.2%) and moderate TMD (34.8%). Pain frequency during mastication, temporomandibular joint (TMJ) pain, and TMJ sounds were shown to be good predictors of TMD severity. Neck pain, headache, difficulty during mouth opening and lateral deviation, and tenderness to palpation of masticatory sites and during protrusion accompanied the TMD severity but failed to demonstrate differences between moderate and severe groups, showing a poor ability to determine TMD severity progression. This study suggests that not only the frequency of signs and symptoms of TMD should be determined, but also symptom severity and its relationship to the presence of clinical signs in order to discriminate patients with real treatment needs in nonpatient samples.

Cervical spine signs and symptoms: perpetuating rather than predisposing factors for temporomandibular disorders in women

Aim: The purpose of this study was to assess in a sample of female community cases the relationship between the increase of percentage of cervical signs and symptoms and the severity of temporomandibular disorders (TMD) and vice-versa. Material and Methods: One hundred women (aged 18-26 years) clinically diagnosed with TMD signs and symptoms and cervical spine disorders were randomly selected from a sample of college students. Results: 43% of the volunteers demonstrated the same severity for TMD and cervical spine disorders (CSD). The increase in TMD signs and symptoms was accompanied by increase in CSD severity, except for pain during palpation of posterior temporal muscle, more frequently observed in the severe CSD group. However, increase in pain during cervical extension, sounds during cervical lateral flexion, and tenderness to palpation of upper fibers of trapezius and suboccipital muscles were observed in association with the progression of TMD severity. Conclusion: The increase in cervical symptomatology seems to accompany TMD severity; nonetheless, the inverse was not verified. Such results suggest that cervical spine signs and symptoms could be better recognized as perpetuating rather than predisposing factors for TMD.

Effects of progressive resistance strength training on knee biomechanics during single leg step-up in persons with mild knee osteoarthritis☆☆☆★

BACKGROUND The goal of this study was to determine if increasing strength in primary knee extensors and flexors would directly affect net knee joint moments during a common functional task in persons with knee osteoarthritis. METHODS An exploratory single sample clinical trial with pre-post treatment measures was used to study volunteers with clinical diagnosis of mild knee osteoarthritis (OA) in one knee. Subjects participated in an individually supervised training program 3 times a week for eight weeks consisting of progressive resistive exercises for knee extensors and knee flexors. Pre and post training outcome assessments included: 1. Net internal knee joint moments, 2. Electromyography of primary knee extensors and flexors, and 3. Self-report measures of knee pain and function. The distribution of lower extremity joint moments as a percent of the total support moment was also investigated. FINDINGS Pain, symptoms, activities of daily life, quality of life, stiffness, and function scores showed significant improvement following strength training. Knee internal valgus and hip internal rotation moments showed increasing but non-statistically significant changes post-training. There were no significant differences in muscle co-contraction activation of the Quadriceps and Hamstrings. INTERPRETATION While exercise continues to be an important element of OA management, the results of this study suggest improvements in function, pain, and other symptoms, as a result of strength training may not be causally related to specific biomechanical changes in net joint moments.

Reliability of electromyographic amplitude values of the upper limb muscles during closed kinetic chain exercises with stable and unstable surfaces.

The purpose of the present study was to evaluate the intra and interday reliability of surface electromyographic amplitude values of the scapular girdle muscles and upper limbs during 3 isometric closed kinetic chain exercises, involving upper limbs with the fixed distal segment extremity on stable base of support and on a Swiss ball (relatively unstable). Twenty healthy adults performed the exercises push-up, bench-press and wall-press with different effort levels (80% and 100% maximal load). Subjects performed three maximal voluntary contractions (MVC) in muscular testing position of each muscle to obtain a reference value for root mean square (RMS) normalization. Individuals were instructed to randomly perform three isometric contraction series, in which each exercise lasted 6 s with a 2-min resting-period between series and exercises. Intra and interday reliabilities were calculated through the intraclass correlation coefficient (ICC 2.1), standard error of the measurement (SEM). Results indicated an excellent intraday reliability of electromyographic amplitude values (ICC > or = 0.75). The interday reliability of normalized RMS values ranged between good and excellent (ICC 0.52-0.98). Finally, it is suggested that the reliability of normalized electromyographic amplitude values of the analyzed muscles present better values during exercises on a stable surface. However, load levels used during the exercises do not seem to have any influence on variability levels, possibly because the loads were quite similar.

Craniocervical posture analysis in patients with temporomandibular disorder

OBJECTIVE: To compare head positioning and cervical spine alignment between individuals with and without temporomandibular disorders (TMDs), by means of positional evaluation using photographs, radiographs and visual observation, and to investigate whether the type of TMD influences head posture and cervical spine positioning. METHODS: Ninety randomly chosen women were diagnosed using the research diagnostic criteria for TMDs (RDC/TMD) by a trained examiner and were divided into three groups: Group 1, with a diagnosis of myofascial dysfunction (group I of RDC axis I); Group 2, with mixed TMD (groups I, II and III of RDC axis I); and Control, without TMD. Following this, the participants were photographed in frontal and lateral views by a single examiner. To produce these photos, the following anatomical points were marked out on the skin: occipital protuberance, C4, C7, acromioclavicular joint and sternoclavicular joint. From these points, different angles were analyzed by means of the ALCimagem-2000 application. These same photos were then evaluated qualitatively (visual evaluation). Next, lateral teleradiography and radiography of the cervical spine was requested. The examiner was blind when analyzing the images. To compare the results, the chi-squared test and analysis of variance were used, with significance levels of 5%. RESULTS: Regardless of the method used, the results revealed that head and cervical spine posture did not differ between the groups with and without TMD, independent of the diagnostic group. CONCLUSION: The posture of individuals with myogenic or arthrogenous TMD does not differ from the posture of individuals without TMD. The presence of TMD does not influence the head and cervical spine posture.